Research | WTC responders exposed earlier to dust cloud have higher risk of atherosclerotic lesions

New York NY |

In the first study using magnetic resonance imaging (MRI) to evaluate cardiovascular risk in World Trade Center (WTC) first responders, researchers from Mount Sinai School of Medicine have found that the responders who experienced high levels of exposure to the initial dust cloud on September 11, 2001, demonstrate high-risk features of atherosclerosis (plaque in arteries). The data were presented at the American Heart Association’s Scientific Sessions 2011 in Orlando, Florida.

Mary Ann McLaughlin, MD, MPH, Associate Professor of Medicine is the primary investigator for this study and has been evaluating the cardiovascular health of the WTC responders since 2007. In addition to the current study, her research has shown more impaired cardiac relaxation and coronary calcification in responders at Ground Zero, compared with the general population.

First author, Venkatesh Mani, PhD, and colleagues, used MRI to evaluate the blood vessels of 19 responders exposed to the high levels of particulate matter from the dust cloud, and 12 exposed to the lower levels. They found that WTC workers who were exposed to the initial dust cloud had higher blood vessel formation in their artery plaque compared to people with lower exposure. Co-investigator, Simonette Sawit, MD also demonstrated impaired vascular reactivity, or dysfunction of the inner lining of blood vessels, in those with higher dust exposure. This dysfunction may accelerate the progression of atherosclerosis. The Mount Sinai team discovered this association in WTC workers independent of other clinical factors.

“Using noninvasive MRI imaging, we were able to see a significant impact of the events of 9/11 on the cardiovascular health of the brave men and women who responded that day,” said Zahi Fayad, PhD, Professor of Radiology, and Medicine in the Division of Cardiology, and the Director of the Translational and Molecular Imaging Institute at Mount Sinai School of Medicine. “Now that we have visualized the risk and early development of vascular lesions, in a subset of subjects, we look forward to studying the use of imaging in the greater patient population.”

“This study defines physiologic change associated with greater exposure to the dust cloud at the WTC site,” said Dr. McLaughlin. “We are currently evaluating other predictors of cardiovascular risk in this population to gain a better understanding of the impact of particulate matter exposure on cardiovascular health.”

This research is funded by Clinical and Translational Science Award, the Translational and Molecular Imaging Institute, Mount Sinai School of Medicine.

The WTC Clinical Center of Excellence at Mount Sinai is a treatment and monitoring program for emergency responders, recovery workers, residents, and area workers who were affected by the terrorist attacks in New York City on September 11, 2001. The program identifies mental and physical health problems needing timely treatment; evaluates the health of first responders; monitors the development of symptoms; and researches the effects of 9/11 through data collection and analysis. Located at Mount Sinai and several other clinics in the tri-state area, the Clinical Centers of Excellence and Data Centers are the result of the James Zadroga 9/11 Health and Compensation Act, which provides $4.3 billion in federal funding to serve the health needs of the brave men and women impacted by the WTC tragedy.

Research | Study documents toll of smoke inhalation injuries

Maywood IL | A study of burn patients has found that those who suffered the most severe smoke inhalation also had more inflammation and spent more time on ventilators and in intensive care.

The study, led by researchers at Loyola University Chicago Stritch School of Medicine, is published ahead of print in the journal Critical Care Medicine. It is the first to show that the severity of smoke-inhalation injury may play a role in the overall pulmonary inflammatory response.

Inflammation occurs in response to injury. It includes the release of proteins that can trigger wound healing. But too much inflammation can damage healthy tissue.

Researchers wrote that their findings could “serve the purpose of better understanding the biological mechanisms behind smoke inhalation injury.”

In the United States, about 40,000 people are hospitalized for burn injuries each year. As many as 20 percent of fire victims also have smoke-inhalation injuries.

At Loyola, smoke inhalation is rated from 0 (no injury) to 4 (massive injury). Researchers conducted an observational study of 60 adult burn patients, including nine patients who had Grade 0 inflammation, 15 who had Grade 1, 15 who had Grade 2, 18 who had Grade 3 and three who had Grade 4.

The study included an examination of proteins called cytokines contained in fluid flushed out of patients’ lungs. (Cytokines are the so-called hormones of the immune system.) Researchers looked at 28 cytokines associated with inflammation, and found that 21 were at their highest in patients with the most severe smoke inhalation injuries. (The inflammatory proteins included interferon-γ, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein-1 and several interleukins.)

Patients who had low smoke-inhalation injuries (Grades 1 or 2) spent a median of seven days on the ventilator, while patients with high-inhalation injuries (Grades 3 or 4) spent a median of 23 days on the ventilator. Low-inhalation-injury patients spent a median of 13 days in intensive care; high-inhalation-injury patients spent 24 days. Thirty-three percent of low-inhalation-injury patients required a tracheotomy, compared with 52 percent of high-inhalation-injury patients. However, the degree of inhalation injury did not have a significant effect on subsequent pneumonia, sepsis, hospital length of stay or mortality.

Senior author of the study is Elizabeth J. Kovacs, PhD, director of Loyola’s Burn and Shock Trauma Institute. First author is Joslyn M. Albright, MD, a research fellow in the Burn and Shock Trauma Institute. “This study is an excellent example of clinicians and basic scientists working together,” Kovacs said.

Other co-authors are Christopher S. Davis, MD, MPH, Melanie D. Bird, PhD, Luis Ramirez, BS, and Richard L. Gamelli, MD, FACS, of Loyola’s Burn and Shock Trauma Institute; Hajwa Kim, MS, MA of the University of Illinois at Chicago and Ellen L. Burnham, MD, MS of the University of Colorado Denver School of Medicine. Gamelli is Director of the Burn and Shock Trauma Institute and Senior Vice President and Provost of Health Sciences of Loyola University Chicago Stritch School of Medicine.

The study is supported in part by funding from the National Institutes of Health, the International Association of Fire Fighters and the Dr. Ralph and Marian C. Falk Medical Research Trust.

In their acknowledgements, authors thanked Jurgen Peters, MD of the Universitatsklinikum Essen in Essen, Germany, and the “dedicated assistance of nursing and support staff in the Burn Intensive Care Unit at Loyola University Medical Center.”

New York | Health dept to survey adolescents about their health ten years after 9/11

New York NY | The World Trade Center (WTC) Health Registry, the largest post-disaster public health registry in United States, launched its third pediatric health survey this month. More than 1,300 adolescent enrollees who were exposed to the WTC disaster will be asked to share valuable information about their health ten years after 9/11, including information about their quality of life, mental health including depression and stress symptoms, smoking/alcohol/drug use, and school involvement. Parents and guardians are also asked to provide information about their child’s physical and mental health. Parents and guardians of adolescent enrollees can obtain more information about completing this survey by e-mailing or calling the Registry at 1-866-692-9827.

“Children and adolescents who were exposed to 9/11 are now ten years older and their health concerns may have changed over the past decade,” said Health Commissioner Dr. Thomas Farley. “We need to hear directly from these young people and their parents. Whether it’s persistent post-traumatic stress disorder or respiratory illness that a young person is dealing with, filling out the WTC Health Registry survey helps us understand the potential long-term health effects of the disaster so we can help people more effectively.”

Data collection will continue through March 2012. Results from this survey will help identify potential late emerging and long-term health effects and address gaps in 9/11 health care services for adolescents. More than 3,000 children under the age of 18 were enrolled by their parents in the Registry when it began in 2003-04. Ten years later, many of the children are now adults and have begun to receive the adult survey as they turn 18.

Parents and adolescents will receive the survey which has two components, a parent survey and an adolescent survey, by mail or email and this is the first time participants will have the option to take the survey online. The survey takes approximately 15-20 minutes to complete and parents must consent to their child filling out the survey. Spanish and Chinese speaking participants will receive translated versions of the survey.

This past summer, the Registry launched its third adult health survey with more than 66,000 enrollees, including enrollees who were children during the second survey, but are now adults age 18 years or older. Nearly 30,000 enrollees have completed the third survey to date.

About the WTC Health Registry

The World Trade Center Health Registry became the largest post-disaster public health registry in United States history when 71,000 people directly exposed to the WTC disaster voluntarily enrolled and completed the initial survey in 2003-04. The Registry was established by the New York City Department of Health and Mental Hygiene and the federal Agency for Toxic Substances and Disease Registry. The National Institute of Occupational Safety and Health has funded the Registry since May 2009. Registry findings continue to contribute to an understanding of the health impacts of 9/11 among persons directly exposed to the disaster. As of October 2011, the Registry has published 23 peer-reviewed papers in scientific journals. Additionally, several university-based researchers have recruited Registry enrollees for other 9/11-related studies and published their findings. More information about the Registry, its findings and opportunities for external researchers can be found on the Registry’s website.